The Medical Staff Structure - Its Role in the 21st Century

Dr. Eisenberg\u27s paper presents a vision of the medical staff from the point of view of a practicing physician and medical staff leader. Dr. Eisenberg focuses on ways the medical staff, as an independent entity, may use the collective clinical knowledge and experience of its physician membership to enhance quality. This paper also presents Dr. Eisenberg\u27s unique insights regarding the interplay and conflict between hospitals and their associated medical staff in today\u27s complex health care delivery system. He provides several suggestions to increase cooperation between these two important components of inpatient care

Molecular mechanisms of cell death: recommendations of the Nomenclature Committee on Cell Death 2018.

Over the past decade, the Nomenclature Committee on Cell Death (NCCD) has formulated guidelines for the definition and interpretation of cell death from morphological, biochemical, and functional perspectives. Since the field continues to expand and novel mechanisms that orchestrate multiple cell death pathways are unveiled, we propose an updated classification of cell death subroutines focusing on mechanistic and essential (as opposed to correlative and dispensable) aspects of the process. As we provide molecularly oriented definitions of terms including intrinsic apoptosis, extrinsic apoptosis, mitochondrial permeability transition (MPT)-driven necrosis, necroptosis, ferroptosis, pyroptosis, parthanatos, entotic cell death, NETotic cell death, lysosome-dependent cell death, autophagy-dependent cell death, immunogenic cell death, cellular senescence, and mitotic catastrophe, we discuss the utility of neologisms that refer to highly specialized instances of these processes. The mission of the NCCD is to provide a widely accepted nomenclature on cell death in support of the continued development of the field

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

The Medical Staff Structure - Its Role in the 21st Century

Dr. Eisenberg\u27s paper presents a vision of the medical staff from the point of view of a practicing physician and medical staff leader. Dr. Eisenberg focuses on ways the medical staff, as an independent entity, may use the collective clinical knowledge and experience of its physician membership to enhance quality. This paper also presents Dr. Eisenberg\u27s unique insights regarding the interplay and conflict between hospitals and their associated medical staff in today\u27s complex health care delivery system. He provides several suggestions to increase cooperation between these two important components of inpatient care

The Efficacy of Guided Imagery and Music (GIM) in the Treatment of Rheumatoid Arthritis

The purpose of this study was to evaluate the effectiveness of the Bonny Method of Guided Imagery and Music on biological and functional articular measures, pain, depression and psychological symptoms in 27 persons (aged 26-78 yrs) with rheumatoid arthritis. Biological and functional markers of disease states were C Reactive Protein, Rheumatoid Factor, Erythrocyte Sedimentation Rate, 50-foot walking speed, morning stiffness, and joint count. The Symptom Checklist-90-R (SCL-90-R), the Long-Form McGill Pain Questionnaire (MPQ), and Center for Epidemiological Studies-Depression Scale were used to assess psychological status. All measurements were collected at the initial interview session, at the 6th GIM treatment session, 2 weeks after the last GIM treatment session, and 8 weeks after the last GIM treatment session. Results from the study show significant decrease in the level of psychological distress as measured by the SCL-90-R and the subjective experience of pain as measured by the Long-Form of the MPQ. GIM appears to be effective in reducing pain and psychological symptoms, improving physical functioning, and, ultimately, in improving the quality of life for those with rheumatoid arthritis. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Practitioner and Site Characteristics that Relate to Fidelity of Implementation: The Early Risers Prevention Program in a Going-to-Scale Intervention Trial

Despite the increased availability of evidence-based prevention programs targeting serious mental health problems, an ongoing challenge within the field of prevention science is transporting prevention programs into real-world settings where their health impact can be fully realized. As part of a going-to-scale study, we examined how context, namely the characteristics of the practitioners and organizations, promotes or impedes fidelity of implementation of prevention efforts. Practitioners delivered Early Risers, an intensive, multicomponent, indicated prevention program across 27 geographically dispersed elementary schools and recorded 3 indexes of fidelity-exposure, adherence, and quality of implementation. As predicted, practitioner characteristics, including personality traits (low neuroticism, high extraversion, openness, and conscientiousness), beliefs (pre-implementation beliefs about program success), and use of flexible coping strategies (reappraisal coping) were related to various fidelity indexes. Contrary to predictions, teachers\u27 negative perceptions of the organizational structure were positively related to fidelity. Follow-up regression analyses suggested that practitioner characteristics differentially predict fidelity for child and family programming